Medication Assisted Therapy as a Conduit to Care for HIV+ CJS Populations Transit

药物辅助治疗作为护理艾滋病毒的渠道 CJS 人群转运

• 批准号: 8294585
• 负责人: SANDRA Ann SPRINGER
• 金额: $ 15.42万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8294585
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adherence; Administrator; Adverse effects; Agonist; Alcohol consumption; Alcohol dependence; Alcohol or Other Drugs use; Alcohols; Area; Award; Awareness; Behavior; Buprenorphine; CD4 Positive T Lymphocytes; Caring; Clinical; Communicable Diseases; Communities; Consensus; Continuity of Patient Care; Criminal Justice; Development; Drug abuse; Drug usage; ERBB2 gene; Education; Evidence based intervention; Evidence based treatment; FDA approved; Funding; Goals; Grant; HIV; Health Policy; Healthcare Systems; Highly Active Antiretroviral Therapy; Imprisonment; Incidence; Independent Scientist Award; Individual; Injection of therapeutic agent; Interdisciplinary Study; International; Intervention; K-Series Research Career Programs; Link; Medical; Medicine; Mental Health; Mentors; Mentorship; Methadone; Methodology; Methods; Morbidity - disease rate; NCI Scholars Program; Naloxone; Naltrexone; Narcotic Antagonists; National Institute of Drug Abuse; National Institute on Alcohol Abuse and Alcoholism; Neurocognitive; Opiate Addiction; Opioid; Opioid Rotation; Outcome; Outcome Study; Overdose; Persons; Pharmaceutical Preparations; Pharmacotherapy; Physicians; Placebo Control; Policy Making; Population; Postdoctoral Fellow; Prevalence; Prevention therapy; Prisoner; Productivity; Protocols documentation; Public Health; Publications; Qualifying; RNA; Recording of previous events; Relapse; Research; Research Activity; Research Personnel; Risk; Risk Behaviors; Risk-Taking; Safety; Societies; Substance Use Disorder; Substance abuse problem; System; Testing; Therapeutic; Time; Training; United States; United States National Institutes of Health; Universities; Viral; Viral Load result; Wood material; Work; addiction; adverse outcome; alcohol abuse therapy; alcohol relapse; antiretroviral therapy; career; community setting; cost; disorder later incidence prevention; drug relapse; experience; hazardous drinking; improved; interest; meetings; model development; mortality; novel; platform-independent; pre-doctoral; prevent; programs; public health relevance; randomized placebo controlled trial; response; standard of care; substance abuse treatment; transmission process; uptake

DESCRIPTION (provided by applicant): This is an independent scientist award to assist in the continued research of Dr. Sandra Springer, who focuses her research on interventions that will improve linkages to care for HIV+ criminal justice populations (CJS) with co-morbid substance use disorders who are transitioning to the community. This award will also increase her time to devote towards mentoring young investigators who share this interest. HIV and drug abuse is concentrated within the CJS, therefore, it is an important place to target and empirically test interventions that address strategies to reduce HIV transmission within the community. When HIV is maximally suppressed decreased infectiousness is the result. HIV+ prisoners successfully achieve suppression during incarceration, however 3 months post-release viral suppression is lost, mostly due to relapse to drugs and alcohol. Opioid dependence (OD) and alcohol dependence (AD) are present in 50-70% of HIV+ prisoners nationally. Relapse to substance use is associated with discontinuation of HAART adherence and increased HIV risk behaviors, the perfect storm for HIV transmission. Effectively treating OD and AD interrupts this relationship and has great potential to improve HIV outcomes. Opioid substitution therapy, especially methadone, has had limited uptake within the CJS due to philosophical, safety, regulatory and staffing concerns. Similarly, pharmacologic interventions to target treatment of AD are essentially nonexistent within the CJS. Therefore, strategies examining the efficacy of naltrexone (NTX), an opioid antagonist approved by the FDA for treatment of both OD and AD, to improve adherence and retention in care, has great appeal to benefit the individual and to reduce HIV transmission within the community. Dr. Springer has been awarded 2 R01s (Project 1, NIDA R01 DA030762; and Project 2, R01 AA018944) that serve as the research platform for this independent scientist award. The specific aim of both studies is to conduct a placebo-controlled RCT of extended-release NTX (XR- NTX) for HIV+ prisoners with OD (project 1) and AD (project 2) who are transitioning to the community. The placebo-control methodology further strengthens any findings that should be demonstrated. HIV treatment, substance abuse, adverse side effects and HIV risk behavior outcomes will be compared in subjects within CJS in New Haven, Hartford and Springfield. This therapeutic approach has great appeal by the CJS, given the ease of monthly injections, lack of diversion, few side effects and no antagonistic philosophical concerns about its use. The strength of this proposal is that Dr. Springer is experienced in HIV, addiction and the CJS; the novel use of pharmacologic interventions to prevent relapse to OD and AD as a means to improve HIV outcomes; over 7 years of conducting research in the CJS; and the novelty of using XR-NTX for the treatment of OD and AD. These trials may demonstrate efficacy and safety, and then XR-NTX is likely to become an evidence-based intervention with released HIV+ prisoners. As such, the individual, our health care system and society have a high likelihood to benefit - especially on the reduction of HIV within the community.

Sandra Springer博士，她的研究重点是干预措施，这将改善与艾滋病毒+刑事司法人群（CJS）的护理联系，这些人群患有共同病态物质使用障碍，正在向社区过渡。这一奖项也将增加她的时间，致力于指导年轻的调查谁分享这一利益。艾滋病毒和药物滥用集中在社区卫生服务中心，因此，这是一个重要的地方，有针对性和经验测试干预措施，解决战略，以减少艾滋病毒在社区内的传播。当艾滋病毒被最大限度地抑制时，结果是传染性降低。艾滋病毒阳性囚犯在监禁期间成功地实现了抑制，但释放后3个月病毒抑制消失，主要是由于重新吸毒和酗酒。全国50-70%的艾滋病毒+囚犯存在阿片类药物依赖（OD）和酒精依赖（AD）。药物使用的复发与HAART依从性的中断和HIV风险行为的增加有关，这是HIV传播的完美风暴。有效治疗OD和AD中断这种关系，并有很大的潜力，以改善艾滋病毒的结果。阿片类药物替代疗法，特别是美沙酮，由于哲学，安全性，监管和人员配置方面的问题，在CJS中的吸收有限。同样，CJS中基本上不存在针对AD治疗的药物干预。因此，研究纳洛酮（NTX）（一种FDA批准用于治疗OD和AD的阿片类拮抗剂）的疗效以改善护理依从性和保留率的策略，对个体有益并减少社区内的HIV传播具有很大的吸引力。施普林格博士已被授予2个R 01（项目1，NIDA R 01 DA 030762;和项目2，R 01 AA 018944），作为这个独立科学家奖的研究平台。这两项研究的具体目的是对正在向社区过渡的艾滋病毒阳性OD（项目1）和AD（项目2）囚犯进行延长释放NTX（XR- NTX）的安慰剂对照RCT。安慰剂对照方法进一步加强了应证明的任何结果。将在纽黑文、哈特福德和斯普林菲尔德的CJS内对受试者的艾滋病毒治疗、药物滥用、不良副作用和艾滋病毒风险行为结果进行比较。这种治疗方法对CJS有很大的吸引力，因为每月注射很容易，没有转移，副作用很少，而且没有对抗性的哲学问题。Springer博士在艾滋病毒，成瘾和CJS方面经验丰富;新使用药理学干预措施来预防OD和AD复发，作为改善艾滋病毒结果的手段;在CJS进行研究超过7年;以及使用XR-NTX治疗OD和AD的新奇。这些试验可能会证明其有效性和安全性，然后XR-NTX很可能成为释放的艾滋病毒+囚犯的循证干预措施。因此，个人、我们的卫生保健系统和社会都很有可能受益，特别是在减少社区内的艾滋病毒方面。